Facial lifting effect of SMAS multi-vector suspension / 中华医学美学美容杂志

Objective:To explore the rejuvenation effect of SMAS (Superficial musculoaponeurotic system) multi-vector suspension in the face and neck.Methods:From December 2019 to March 2023, the Plastic Surgery Department of the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences implemented 34 cases of cheek rhytidectomy and 10 cases of cheek andneck rhytidectomy. Following general anaesthesia, liposuction is performed on the cheek and mandibular margins, and incisions are made anterior and posterior to the ear. At the end of the subcutaneous dissection, the SMAS in the region of the parotid gland is separated, and the SMAS is then secured by purse string multi-vector suture suspension. Intheend, excess skin is removed and the incision is reduced in tension.Results:All patients underwent successful surgeries and were satisfied with the postoperative follow-up results. The sagging soft tissues were effectively repositioned, resulting in natural facial and neck lift. There were no serious complications such as facial nerve injury, subcutaneous hematoma, incision infection, or skin flap necrosis.Conclusions:The utilization of MAS multi-vector suspension can significantly improve the relaxation of cheek and neck tissue, with fewer complications and satisfactory rejuvenation effect.

3D stereophotogrammetry quantification for tissue repositioning using Botulinum toxin A: a case report / Quantificação por estereofotogrametria 3D para reposicionamento tecidual com Toxina botulínica A: relato de caso

Hereby, we objectively assessed the outcomes of a facial-lifting procedure with Botulinum toxin type A (BoNT-A) using a 3D stereophotogrammetry quantification (3D-SQ). A 46-year-old female patient received a full face BoNT-A treatment in a total dose of 180 Speywood Units (sU). Frontal, lateral and oblique photographs were taken before and 20 days after treatment, at rest and during mimic movements. Also, a facial scanning was performed before and 20 days after BoNT-A injections. The results were analyzed using a 3D-SQ software. The photographs showed a decrease in expression lines and dynamic wrinkles. In addition, a better-defined jawline and volume gain in the midface area with improvement of the profile appearance, due to the reduction of the sagging skin under the chin, was observed. The 3D-SQ showed volume gains of 1.17 ml on the right and of 1.59 ml on the left cheekbone areas, due to the cranially soft-tissue repositioning. In addition, a decrease in the volume of melomental folds areas (0.27ml on the right and 0.41 ml on the left side) was reported, compatible to the above-mentioned volume gain. Measurements considering cephalometric points showed a decrease in the total facial height (distance from Trichion to Mental points), suggesting a soft tissue dislocation in an upward direction. Finally, this case report showed quantitative results that can evidence the role of BoNT-A in facial- lifting procedures. These results reinforce the importance of using a 3D-SQ to assess the outcomes of BoNT-A and, probably, other aesthetic procedures.(AU)

No presente estudo avaliamos objetivamente os resultados de um procedimento de lifting facial com toxina botulínica tipo A (BoNT-A) usando uma quantificação de estereofotogrametria 3D (3D-SQ). Uma paciente do sexo feminino de 46 anos recebeu um tratamento facial completo com BoNT-A em uma dose total de 180 unidades Speywood (sU). Fotografias frontais, laterais e oblíquas foram tomadas antes e 20 dias após o tratamento, em repouso e durante os movimentos mímicos. Além disso, um escaneamento facial foi realizado antes e 20 dias após as injeções de BoNT-A. Os resultados foram analisados por meio de um software 3D-SQ. As fotografias mostraram uma diminuição das linhas de expressão e rugas dinâmicas. Além disso, observou-se um maxilar mais bem definido e ganho de volume na região média da face com melhora da aparência do perfil, devido à redução da flacidez da pele sob o queixo. O 3D-SQ apresentou ganho de volume de 1,17 ml à direita e 1,59 ml à esquerda, devido ao reposicionamento do tecido mole. Além disso, foi relatada diminuição do volume das áreas do sulco mentual (0,27 ml à direita e 0,41ml à esquerda), compatível com o ganho de volume acima citado. As medidas considerando os pontos cefalométricos mostraram uma diminuição da altura facial total (distância dos pontos Triquion ao Mentual), sugerindo um deslocamento superior dos tecidos moles. Em conclusão, este relato de caso mostrou resultados quantitativos que podem evidenciar o papel da BoNT-A em procedimentos de lifting facial. Esses resultados reforçam a importância da 3D-SQ para avaliar objetivamente os resultados de harmonização orofacial com BoNT-A e outros materiais. (AU)

Anatomical basis and clinical application on using botulinum toxin type A to treat facial laxity / 中华整形外科杂志

Objective@#To study the anatomical morphology of the platysma muscle of the lower face, so as to provide anatomical basis for the treatment of facial laxity by injection of botulinum toxin type A. To explore the safe injection site of botulinum toxin type A in the treatment of facial relaxation, and to explore the effect of botulinum toxin type A.@*Methods@#① Extensively dissect and analysis of 30 hemi-faces in 15 cadavers . Exposed the platysma muscle of the lower face, and measured the width of the platysma muscle, the extension angle in face, and coverage of the face. Then use SPSS 22.0 software to statistical analysis. ②Analysis clinical data of the treatment of facial laxity patients using botulinum toxin type A from August 2015 to October, 2017.Inject botulinum toxin type A to the platysma muscle of the lower face. Standardized photograph patients before and after injection. Use Photoshop CC to measure the facial ascension and the mandibular margin ascending angle before and after treatment. Use SPSS 22.0 software to statistical analysis the measured data before and after treatment.@*Results@#①According to the direction of the platysma muscle, the direction of posterior muscle bundle can be divided into straight, straight-curved and curved three categories, accounting for 36.7%, 50.0% and 13.3% respectively, and in all cases, it covered the mandibular angle. The distribution of the high peak of the posterior muscle beam in the platysma muscle was statistically significant, indicating that the structure and distribution of the platysma muscle varied greatly, whereas the broad of muscle is stable and the distribution table was shallow. ② Injected botulinum toxin type A in designed site of platysma muscle, and used the " ring diameter rule" to measure the data of the lower part before and after injection. Then compared data from two groups and check whether the difference between the two groups was statistically significant. It is the indicator that the treatment was effective.@*Conclusions@#①The platysma muscle is thin and the thickness of the muscle is thin, and the morphological distribution varied greatly, so the platysma muscle injection site is pressed against the lower jaw. You should try to be shallow during injection. ②The treatment of the following contour morphology was improved by the botulinum toxin type A injection and the therapeutic effect was positive.

Application of muscle pedicled platysma myocutaneous flap in the reconstruction of buccal mucosa defects / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aimed to explore the main features and advantages of the muscle pedicled platysma myocutaneous flap (PMF), the degree of improvement of flap harvest. To evaluate the application value of the flap in the reconstruction of buccal mucosa carcinoma defects.</p><p><b>METHODS</b>Twenty-three patients received PMF with MacFee incision to reconstruct buccal mucosa defects that were caused by the resection of precancer lesions and benign and malignant tumors from August 2012 to April 2015. When elevating the cervical skin from the platysma, most of the subcutaneous tissue was preserved on the muscle. The continuity of the facial vessels was retained. The external jugular vein was preserved on the reverse side of the platysma.</p><p><b>RESULTS</b>Twenty-one flaps survived completely, whereas the other two flaps presented partial skin loss. Two patients showed disturbed wound healing in the neck. Secondary healing was achieved after attentive wound care. All patients were followed up from 11 to 43 months. The function of the recipient sites recovered well. Except for the two patients with large-area scarring in the neck, the remaining cases presented satisfactory neck contours. No relapses were observed during the follow-up period.</p><p><b>CONCLUSIONS</b>Compared with the traditional PMF, the muscle pedicled PMF provides a larger skin paddle and presents a better aesthetic and functional effect. Thus, this approach is a novel and ideal option for the restoration of buccal mucosa defects.</p>

Application of platysma myocutaneous flap with apron incision in the restoration of oral and maxillofacial defects / 实用口腔医学杂志

Objective:To introduce a new style of platysma myocutaneous flap and to evaluate its application value in the restoration of oral-maxiofacial defects.Methods:Platysma myocutaneous flap with apron incision was used for the restoration of oral-maxiofacial defects after oral lesion ablation in 15 cases from January,2014 to September,2015.The platysma muocutaneous flap was harvested with a U shaped apron incision.The skin above the flap pedicle was preserved.The platysma pedicle was widened to ensure the flap survival.All the patients were followed up form 4 to 33 months.Results:Of the 15 platysma myocutaneous flaps,12 survived completely and 3 had partial flap necrosis.The total survival rate of the flaps at the recipient site of buccal mucosa,tongue and alveolar was 8/9,1/3 and 3/3 respectively.Additionally,there were 2 cases of disturbed wound healing in the neck.Except for 1 case of carcinoma of gingiva which had apparent cervical scar and 1 case of tongue carcinoma which had limited tongue mobility,the other cases showed a satisfactory recovery of oral-maxillofacial contour and fucnction.Conclusion:Compared with the traditional platysma myocutaneous flap,the platysma myocutaneous flap with apron incision can provide a larger skin paddle,and is suitable for the restoration of small and medium sized buccal mucosa and alveloar defects,but not for tongue defect.

Transversus menti muscle in a thai cadaver / Músculo transversus menti en un cadaver tailandés

In submental and around the mouth areas, the superfacial muscles are considered in surgery of some deformities of mouth angle. Herein, we report a rare case of the Transversus menti muscle (TM) in a Thai 74 year-old male cadaver. This TM originated from both sides of the oblique line of depressor anguli oris and formed as transverse fibers in submental area. Their fiber ran under the chin and was superficial to platysma muscle. The TM was innervated and supplied by mandibular branches of facial nerve and small branches of the submental artery. This report attempted to discuss the possible function and clinical significance of the TM.

Alrededor de la boca y en áreas submentonianas, los músculos superficiales son considerados en la cirugía de algunas deformidades del ángulo de la boca. Este estudio presenta un caso raro de músculo transversus menti (TM), en un cadáver tailandés de sexo masculino de 74 años de edad. El músculo TM se originó a partir de los dos lados de la línea oblicua del músculo depresor del ángulo oral y se formó como fibras transversales en el área submentoniana. Sus fibras se desplazaron debajo del mentón y superficialmente al platisma. El músculo TM estaba inervado e irrigado por ramos mandibulares de nervio facial y pequeñas ramas de la arteria submentoniana. Se discute su posible función y el significado clínico del músculo TM.

Platysma myocutaneous flap - its current role in reconstructive surgery of oral soft tissue defects

Reconstruction of oral soft-tissue defects following resection of oral carcinomas can be achieved using various techniques including microsurgical tissue transfer. However, there seems to be a role for regional or local flaps. Small to medium-size defects can be functionally reconstructed with the platysma myocutaneous flap as an excellent choice particularly in medically compromised patients not being eligible for free tissue transfer. The present paper reviews the indication, surgical technique, and complications following reconstruction of defects of the oral cavity with the platysma myocutaneous flap.

Lifting cervical gravitacional / Gravitational cervical lifting

Introdução: Os procedimentos cirúrgicos visando ao rejuvenescimento facial vêm evoluindo desde 1920. Os primeiros relatos descreviam pequenas ressecções de pele que se revelaram totalmente ineficazes. A exigência progressiva por melhores resultados ocasionou a busca por abordagens cirúrgicas mais eficazes, principalmente no que diz respeito ao tratamento do terço inferior da face e pescoço, onde as deformidades eram mal corrigidas ou apresentavam recidiva precoce. Objetivo: Apresentar uma nova abordagem para o tratamento do terço inferior da face, principalmente nos pacientes que apresentam grande flacidez de pele e dos músculos platismas, com ou sem excesso de gordura na região cervical, pois com as condutas atuais existe elevada taxa de resultados insatisfatórios. Método: Cento e oitenta pacientes foram operados, seguindo técnica proposta pelo autor sênior, e acompanhados durante cinco anos (janeiro de 2003 a maio de 2008) foram avaliados. Foram analisadas 172 (95,6%) pacientes do sexo feminino e 8 (4,4%) do masculino. A média de idade foi de 57,7 anos, tendo 41 anos e 1 mês o mais jovem e 81 anos e 5 meses o mais idoso. Na maioria dos casos, realiza-se extensa lipectomia com tesoura, completa dissecção das bandas platismais com posterior ressecção total da flacidez das bandas platismais e seu tracionamento vetorial inferior, além da tração oblíqua da pele na região cervical em sentido à linha de implantação do cabelo na região cervical. Conclusão: Os efeitos duradouro se o sucesso da técnica podem ser comprovados pelo crescente número de procedimentos realizados neste período e pela grande satisfação dos pacientes.

Background: The surgical procedures searching the anti aging face come evolving since 1920. The first stories described small resections of skin that if had disclosed inefficacious total. The gradual requirement for better resulted caused the search for more efficient surgical procedures mainly in what it says respect to the treatment of the cervical region of face and neck where the deformities were badly corrected or presented precocious return. Objective: The objective of this study was to introduce a new approach for treatment of the cervical region of face and neck, mainly in the patients who present great flaccidity of skin and the muscles platysma, with or without excess of fat in the cervical region, therefore with the current behaviors still we have resulted unsatisfactory. Method: One hundred and eighty patients had been operated, following the technique of gravitational cervical lifting, and followed during five years (January of 2003 to May of 2008). There were 172 (96.6%) women and 8 (4.4%) men. The average age was 57.7 years old, the young est was 41 years old and the oldest was 81 years old. Conclusions: In most cases is done extensive lipectomy using scissors, complete resection of the platysma bands and their traction vector lower. Besides, it made the skin traction in the cervical area in oblique sense to the line of hair implantation in the cervical area. The durable effect and the success of this technique can be proved by the increase in the procedure number performed in this period and by the great patient’s satisfaction.

Clinical application of combined platysma-fascial flap with free dermis fat graft to fill sunken cheek deformity / 中华医学美学美容杂志

Objective To explore the method of treatment of sunken cheek deformity.Methods The longitudinal platysma-faseial flap was overturned 180 degree upward,the flap's pedicle located in the margin of mandible,and then combined with abdominal dermis fat graft to form as a sandwich,which filled in the sunken area of face.Results Five patients were treated with this method from 2003 to 2007,and satisfactory results were gained but only mild absorption was found in the transplanted tissue area during followed up for 3 months to 3 years.Conclusion Platysma-fascial flaps survive easily with rich blood supply and strong anti-infection,and are also easy to incise and operate as well,which,together with free abdominal dermis fat flap,could increase the amount of the needed tissue.It is a better approach to repair the sunken cheek deformity and in particular suitable for the more serious deformity in patients with sunken cheek.

Platysma flap in the prevention of sweating gustatory syndrome / 实用口腔医学杂志

Objective:To explore the preventive function for sweating gustatory syndrome and esthetic effect of restoring parotid gland area defect by using platysma flap. Methods: Nine patients who underwent parotidectomy and restored parotid gland area defect with platysma flap were analyzed retrospectively in this study. Observed whether there was an incidence of subjective sweating gustatory syndrome and introcession in the operation region. Results: There was no incidence of subjective sweating gustatory syndrome. Moreover, introcession in the operation region was not obvious. Conclusion: Restoring parotid defects with platysma flap can reduce introcession in the operation region. Application of platysma flap as an interpositional barrier between the skin flap and the parotid bed after parotidectomy can reduce the incidence of sweating gustatory syndrome.

A clinical study on superiorly based platysma myocutaneous cervical flap for reconstruction following intraoral soft tissue cancer surgery

Combined Approach for Rejuvenation of the Lower Third of the Face and the Neck in the Male Patient

Most men develop deep crease in the nasolabial area and visible redundant tissue in the anterior neck with aging. The ideal operation for those patients seeking facial rejuvenation because of prominent nasolabial folds and neck soft-tissue laxity is the cervicofacial rhytidectomy. If the patient doesn't wish to have a conventional face/neck lift under general anesthesia, a combined approach based on summation of partially effective modalities is a good option. We present our experience with combined subcutaneous neck lift, platysmaplasty, mentoplasty, and platysma graft in the treatment of the lower third of the face and the neck, and obtained good results without complications using this comprehensive approach. In terms of morbidity, the procedure left inconspicuous scars. The platysma grafts remained in place and were not palpable and/or perceptible after insertion. Finally, postoperative recovery occurred uneventfully and no patients presented complications or the need for complementary treatment modalities. The incorporation of this innovative technique will provide us with more choices for addressing this controversial issue with a combined approach. The combination of proven methods may have better results than each one alone. It is a simple, safe, and inexpensive procedure that leaves no visible scars and has long-term adequate outcome. In conclusion, the presented procedure offers an additional technique of rejuvenating the lower third of the face and the neck with excellent results in the male patients.

Prevention and treatment of stricture after esophageal burns in 168 cases / 中华创伤杂志

Objective To summarize our experience in prevention and treatment of stricture after esopageal burns in the past thirty years.Methods There were 168 cases in this series.Of them,158 cases underwent surgical management in this study.Modified intraluminal stenting was used in 34 cases, colon interposition without resection of strictured esophagus in 77 cases,gastric transposion with resection of the stricture in 27,repair of cervical stricture with platysma myocutaneous flap in 22,and miscellane- ous operation in 12.Eleven cases experienced operation twice or more at our department.Results Twenty-nine cases recovered after treatment with intraluminal stenting,and 5 re-experienced stricture after stent removal.One of the 5 cases with failed stent responded to bougienage,and the remaining 4 cases re- quired esophageal reconstruction later.Of the 77 colon interpositions,5 cases died postoperatively,and complications of cervical anastomotic fistula occurred in 14 cases,anastomotic stenosis in 4,and abdomi- nal incision dehiscence in 2 cases.In the 27 cases with gastric transpositions,postoperative complications of anastomotic stricture occurred in 2 cases and empyema in 1 patient.There was a cervical leak in 3 ca- ses of the 22 cases treated with the repair of cervical esopageal or anastomotic stricture with a platysma myocutaneous flap.In the 12 cases treated with miscellaneous operation,one died of intestinal obstruc- tion.All the survivors had regular diet after discharge.Conclusions Intraluminal stenting can prevent the formation of caustic esophageal stricture.The location of the cicatricial esophagus dictates whether to perform concomitant esophagectomy during esophageal reconstruction.Platysma myocutaneous flap repair is an excellent method for the treatment of severe cervical esophageal or anastomotic stricture.

Platysma myocutaneous flap for hypopharyngeal reconstruction.

Ten male patients with hypopharyngeal and/or laryngeal cancer underwent hypopharyngeal reconstruction after tumor ablation, using platysma myocutaneous flaps. Their age ranged from 41-82 years, (mean age of 62.7 years). All were examined by barium swallowing before and 2 weeks after operation in order to compare the size and function of hypopharynx. The immediate postoperative period was uneventful and satisfactory except one patient (10%) who suffered from the separation of suture lines on the flap leading to the development of saliva fistula and neck infection. The surgical technique, minor complications and long-term postoperative results were fully described in the report.